Department of Radiation Oncology, Mayo Clinic, Rochester, United States; Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, United States.
Department of Radiation Oncology, Mayo Clinic, Rochester, United States.
Radiother Oncol. 2020 May;146:29-36. doi: 10.1016/j.radonc.2020.02.008. Epub 2020 Feb 27.
PURPOSE/OBJECTIVE(S): To report tumor genomic factors associated with overall survival (OS) and local failure (LF) for patients with colorectal cancer (CRC) who received metastasis-directed stereotactic body radiation therapy (SBRT).
MATERIALS/METHODS: This was a retrospective review of patients with CRC who received metastasis-directed SBRT. Tumor genomic alterations were identified through KRAS, BRAF, or a 50-gene next generation sequencing panel. OS and LF were estimated using Kaplan-Meier and competing-risk methods.
Eighty-five patients and 109 lesions were treated between 2008 and 2018. The median patient follow-up was 50 months (IQR: 28-107). The median and 5-year OS was 34 months and 26% (95% CI: 16-41%), respectively. The 2-year cumulative incidence of LF was 30% (95% CI: 23-41%). Univariate associates with OS included patient age ≥60 years, bone metastasis, increasing tumor size, KRAS mutation, and combined KRAS and TP53 mutation, while increasing tumor size, bone metastasis, biologically effective dose <100 Gy, and combined KRAS and TP53 mutation were associated with LF. Multivariate associates with OS included patient age ≥60 years (HR: 2.4, 95% CI: 1.2-4.8, p = 0.01), lesion size per 1 cm (HR: 1.3, 95% CI: 1.1-1.5, p < 0.01), and KRAS mutation (HR: 2.2, 95% CI: 1.2-4.3, p < 0.01), while no multivariable model for LF retained more than a single variable.
Genomic factors, in particular KRAS and TP53 mutation, may assist in patient selection and radiotherapeutic decision-making for patients with oligometastatic CRC. Prospective validation, ideally with genomic correlation of all irradiated metastases, is warranted.
报告接受转移性立体定向体放射治疗（SBRT）的结直肠癌（CRC）患者的肿瘤基因组因素与总生存（OS）和局部失败（LF）的关系。
材料/方法：这是一项对接受转移性 SBRT 的 CRC 患者进行的回顾性研究。通过 KRAS、BRAF 或 50 基因下一代测序面板确定肿瘤基因组改变。使用 Kaplan-Meier 和竞争风险方法估计 OS 和 LF。
2008 年至 2018 年间，85 名患者和 109 个病灶接受了治疗。中位患者随访时间为 50 个月（IQR：28-107）。中位和 5 年 OS 分别为 34 个月和 26%（95%CI：16-41%）。2 年 LF 的累积发生率为 30%（95%CI：23-41%）。与 OS 相关的单因素包括患者年龄≥60 岁、骨转移、肿瘤大小增加、KRAS 突变和 KRAS 与 TP53 联合突变，而与 LF 相关的因素包括肿瘤大小增加、骨转移、生物有效剂量<100Gy 和 KRAS 与 TP53 联合突变。OS 的多因素相关因素包括患者年龄≥60 岁（HR：2.4，95%CI：1.2-4.8，p=0.01）、每 1cm 病变大小（HR：1.3，95%CI：1.1-1.5，p<0.01）和 KRAS 突变（HR：2.2，95%CI：1.2-4.3，p<0.01），而 LF 多变量模型保留的单一变量不超过一个。
基因组因素，特别是 KRAS 和 TP53 突变，可能有助于选择寡转移 CRC 患者并做出放射治疗决策。需要进行前瞻性验证，理想情况下是对所有放疗转移灶进行基因组相关性分析。
